Urinary Incontinence in Men

Topic Overview

What is urinary incontinence in men?

Urinary
incontinence is the accidental leaking of urine. It's not a disease. It's a
symptom of a problem with a man's
urinary tract.

Urine is made by the
kidneys and stored in a sac made of muscle, called the
urinary
bladder. A tube called the
urethra leads from the bladder through the prostate
and penis to the outside of the body. Around this tube is a ring of muscles
called the urinary sphincter. As the bladder fills with urine, nerve signals
tell the sphincter to stay squeezed shut while the bladder stays relaxed. The
nerves and muscles work together to prevent urine from leaking out of the
body.

When you have to urinate, the nerve signals tell the muscles
in the walls of the bladder to squeeze. This forces urine out of the bladder
and into the urethra. At the same time the bladder squeezes, the urethra
relaxes. This allows urine to pass through the urethra and out of the body.

Incontinence can happen for many reasons:

If your bladder squeezes at the wrong time,
or if it squeezes too hard, urine may leak out.

If the muscles
around the urethra are damaged or weak, urine can leak out even if you don't
have a problem with your bladder squeezing at the wrong time.

If your bladder doesn't empty when it should, you are left with too much urine in the bladder. If the bladder gets too full, urine will
leak out when you don't want it to.

If something is blocking your
urethra, urine can build up in the bladder. This can cause leaking.

Urinary incontinence happens more often in older men than
in young men. But it's not just a normal part of aging.

What are the types and symptoms of urinary incontinence ?

Urinary incontinence can be short-term or long-lasting (chronic).
Short-term incontinence is often caused by other health problems or treatments.
This topic is about the different types of chronic urinary incontinence:

Stress incontinence
means that you leak urine when you sneeze, cough, laugh, lift something, change position, or do something that puts
stress or strain on your bladder.

Urge incontinence is an urge to urinate that's so strong that
you can't make it to the toilet in time. It also happens when your bladder
squeezes when it shouldn't. This can happen even when you have only a small
amount of urine in your bladder. Overactive bladder is a kind of urge
incontinence. But not everyone with an overactive bladder leaks urine.

Overflow incontinence means that you have the urge to urinate, but you can release only a small amount. Since your
bladder doesn't empty as it should, it then leaks urine later.

Total incontinence means that you are always leaking urine.
It happens when the sphincter muscle no longer works.

Functional incontinence means that you can't
make it to the bathroom in time to urinate. This is usually because something
got in your way or you were not able to walk there on your own.

What causes urinary incontinence in men?

Different
types of incontinence have different causes.

Stress incontinence
can happen when the prostate gland is removed. If there has been damage to the
nerves or to the sphincter, the lower part of the bladder may not have enough
support. Keeping urine in the bladder is then up to the sphincter alone.

Urge incontinence is caused by bladder muscles that squeeze so
hard that the sphincter can't hold back the urine. This causes a very strong
urge to urinate.

Overflow incontinence can be caused by something blocking the urethra, which
leads to urine building up in the bladder. This is often caused by an enlarged
prostate gland or a narrow urethra. It may also happen because of weak bladder
muscles.

In men, incontinence is often related to prostate
problems or treatments.

Drinking alcohol can make urinary
incontinence worse. Taking prescription or over-the-counter drugs such as
diuretics, antidepressants, sedatives, narcotics, or nonprescription cold and
diet medicines can also affect your symptoms.

How is the cause diagnosed?

Your
doctor will do a physical exam, ask questions about your symptoms and past
health, and test your urine. Often this is enough to help the doctor find the
cause of the incontinence. You may need other tests if the leaking is
caused by more than one problem or if the cause is unclear.

How is it treated?

Treatments depend on the type of incontinence you have and how much it
affects your life. Your treatment may include medicines, simple exercises, or both. A few men need
surgery, but most don't.

There are also some things you can do
at home. In many cases, these lifestyle changes can be enough to control
incontinence.

Cut back on caffeine drinks, such as coffee and
tea. Also cut back on fizzy drinks like soda pop. And limit alcohol to no more than 1
drink a day.

Eat foods high in fiber to help avoid
constipation.

Don't smoke. If you need help quitting, talk to
your doctor about stop-smoking programs and medicines. These can increase your
chances of quitting for good.

Stay at a healthy
weight.

Try simple pelvic-floor exercises like Kegels.

Go to the bathroom at several set times each day. Wear clothes that you can
remove easily. Make your path to the bathroom as clear and quick as you
can.

When you urinate, practice double voiding. This means going
as much as you can, relaxing for a moment, and then going again.

Use a diary to keep track of your symptoms and any leaking of urine. This can help you and your doctor find the best treatment for you.

If you have symptoms of urinary incontinence, don't be
embarrassed to tell your doctor. Most people with incontinence can be helped or
cured.

A need to strain while
urinating and a sense that the bladder is not empty.

An urgent need
to urinate, often at night.

Leaking urine while asleep.

What Happens

Urinary incontinence is often related to prostate problems. As men age,
the prostate gland grows larger. It can squeeze the
urethra and push the neck of the
bladder out of position. These changes can lead to
incontinence.

Stress incontinence happens when the
muscle (sphincter) surrounding the
urethra opens at the wrong time. This can
be when you laugh, sneeze, cough, lift something, or change posture.

Urge incontinence happens when bladder contractions are too strong to be stopped by the
sphincter. Often the urge is a response to something that makes you expect to urinate. It can happen when you wait to use a toilet, unlock the door when you come
home, or even turn on a faucet.
Overactive bladder is a kind of urge incontinence. But not
everyone with overactive bladder leaks urine. For more information, see the
topic
Overactive Bladder.

Overflow incontinence usually is caused by blockage of the urethra from
BPH or
prostate cancer. It also happens when the bladder muscles contract
weakly or don't contract when they should.

Functional incontinence can happen when there are physical or mental limitations that restrict a man's ability to reach
the toilet in time.

In most cases, incontinence caused by an enlarged prostate can be
cured by medicine or prostate surgery.

If your incontinence is not related to prostate surgery and
it appears suddenly, it will usually clear up after you get treatment
for whatever is causing it. For example, incontinence related to
a
urinary tract infection,
prostatitis, or constipation will most likely
disappear when the infection or condition is cured.

What Increases Your Risk

Many things have been
linked to an increased risk of
urinary incontinence in men.

Watchful waiting

If you have chronic
urinary incontinence that begins slowly, you may be
able to control the problem yourself. If home treatment doesn't control your problem, or if incontinence
bothers you, ask your doctor about treatment.

If you have incontinence that begins suddenly
(acute), call your doctor. Acute incontinence is often caused by urinary tract
problems or medicines. It can be easily corrected.

Who to see

Any of the following health professionals can diagnose
and treat
urinary incontinence:

Exams and Tests

To learn the cause of your
urinary incontinence, your doctor will first review your medical history and give you a physical exam. Along with routine testing, such
as a urinalysis, this may be all your doctor needs to diagnose the cause and start treatment.

Your
doctor may ask you to keep a
voiding log. This is a record of the amount of
liquids you drink and how much and how often you urinate.

Incontinence testing

Tests
that may be done to find the type and cause of your urinary incontinence
include:

Uroflowmetry.
This test measures your rate of urine flow. A low
peak flow rate can be a sign of a blockage or a weak bladder.

Pressure flow studies. This testing measures pressure changes in the bladder as the flow changes. It is often used when
the cause of a man's symptoms is uncertain. It can help show if the cause may be a blockage or a problem with the bladder muscles or nerves.

Treatment Overview

If there is no infection or
cancer or other cause that could only be cured by surgery, treatment is done in stages.

Behavioral strategies may be enough to control your symptoms. These include simple changes to your diet, lifestyle, and urinary habits. See Home Treatment for more information.

Medicines that treat infection or bladder muscle spasm may help.

Self-catheterization may
help you manage
overflow incontinence from a weak bladder or blockage. It may also be used if surgery is not the best option for you. When you need to drain your bladder, you insert a thin, hollow tube through your urethra into the bladder. To learn more, see Other Treatment.

Surgery is usually considered when it is the only treatment
that can cure the incontinence, such as when the condition is caused by a
bladder blockage.

Get some exercise every day. Try to do moderate activity at least 2½ hours a week. Or try to do vigorous activity at least 1¼ hours a week. It's fine to be active in blocks of 10 minutes or more throughout your day and week.

Take a fiber supplement with psyllium (such as Metamucil) or methylcellulose (such as Citrucel) each day. Read and follow all instructions on the label.

Schedule time each day for a bowel movement. Having a daily routine may help. Take your time and don't strain.

If you are
overweight, try to lose some weight. Be more active, and make small, healthy changes to what and how much you eat. You will notice good results over time.

Urinary habits

Try one or more of these tips. They may help you gain some control over your symptoms:

Set a schedule for urinating every 2 to 4
hours. Go whether or not you feel the need.

Practice "double
voiding." This means urinating as much as possible, relaxing for a few moments, and then
urinating again.

If you have trouble reaching the bathroom before
you urinate, consider making a clearer, quicker path to the bathroom. Wear clothes that are easy to take off (such as those with elastic waistbands
or Velcro closures). Or keep a urinal close to your bed or chair.

Talk with your doctor about all the medicines you take,
including nonprescription medicines, to see if any of them may be making
your incontinence worse.
Medicines that may cause urinary incontinence in men
include certain antidepressants, sedatives, and even some allergy and cold
medicines.

Antidepressant medicines, such as imipramine, may help with bladder control.

What to think about

Some medicines that are used to treat
incontinence may actually make it worse in men whose incontinence is
caused by an enlarged prostate gland (benign prostatic hyperplasia, or BPH). So consulting with a urologist is an important
part of incontinence care.

Surgery

Surgery may be
an option for men who:

Have ongoing (chronic)
incontinence.

Have severe symptoms and total
incontinence.

Are extremely bothered by their
symptoms.

Have problems with urinary retention.

Have
moderate to severe blood in the urine (hematuria) that keeps coming back.

Have urinary tract infections that keep coming back.

Have a medical problem that can only be treated with surgery. One example is a bladder outlet
blockage that is affecting kidney function.

Stress incontinence caused by removal of the prostate gland may also be treated with surgery if
the incontinence isn't cured after a period of watchful waiting.

Surgery for severe stress incontinence that does not improve with
behavioral methods includes:

Artificial sphincter. A silicone rubber device is fitted around the urethra (the tube that carries
urine from your bladder to the outside of your body). It can be inflated or
deflated to control urination.

Urethral bulking. Material is injected around the urethra. This serves to control
urination by either closing a hole in the urethra or building up the thickness
of the wall of the urethra.

Bulbourethral sling. A sling is placed beneath the
urethra. It is attached to either muscle
tissue or the pubic bone. The sling compresses and raises the urethra. This gives
the urethra greater resistance to pressure from the belly. Sling surgery may be considered as a treatment for severe urinary incontinence from prostate
surgery.

Sacral nerve stimulation (SNS). An electrical stimulator under your skin sends pulses to the sacral nerve in your lower back. This nerve plays a role in bladder storage and emptying.

What to think about

Surgery works for some people and not others. It is most likely to improve incontinence when:

The diagnosis is right.

The cause of your symptoms is something that can be fixed by surgery.

Your surgeon is very experienced and skilled with the surgery you're having.

Things that can lead to disappointing results include:

Unrealistic expectations. Surgery won't always cure the symptoms, but it will usually improve them.

Behavioral therapy

Continence products

Products such as
absorbent pads or diapers, incontinence clamps, or
pressure cuffs may be used to manage any form of incontinence. Some of these
products absorb leaked urine. Others put pressure on the urethra to help
prevent urine from leaking.

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